What Can (Really) Be Done about Hair Loss?

Hair loss is much more common than you might think: Almost 50 percent of women suffer from hair loss at some point in their lives. The reasons range from hormones and genetics to easy-to-miss, surprisingly significant stressors in our lives. The science is still out on a lot of hair-loss solutions, says New York dermatologist and psychiatrist Amy Wechsler, MD. “There is some good research, though,” she says. “The best place to start is with what’s causing the loss in the first place.”

“Many people have a genetic predisposition toward hair loss,” says Wechsler. “The method of inheritance is not nearly as clear in women as it is in men, but hair loss in general certainly runs in families. Unlike men, women tend not to lose the frontal hairline. Instead, their overall hair becomes thinner as the hair follicles are miniaturized.”

Hormones factor in, too. “Estrogen has a positive effect on hair growth and can prolong the growth phase,” says Carlos Wesley, MD, a New York surgeon specializing in surgical and nonsurgical treatments for hair loss. “During pregnancy, when estrogen levels are high, women often have voluminous hair. Toward the end of the third trimester, estrogen levels drop, and levels of cortisol—the stress hormone—rise. The combination of these forces often leads to increased hair shedding in the months following pregnancy.” Women can also experience hair loss as they approach and go through menopause. “This is often a time when a genetic predisposition toward some hair loss can really kick in,” says Wechsler.

Plain old stress turns out to be a powerful factor in hair loss, too. “It can be physical, like anesthesia for a surgery, or psychological, like a death in the family, a personal scare about something, a divorce, or a breakup,” says Wechsler. “Hair follicles are sensitive to both physical and emotional stressors.” Hair loss can often show up three to six months after the stressor occurs, sometimes making it hard to pinpoint the cause. If it’s just a temporary period of stress, hair growth usually resumes within a couple of months.

Other reasons for hair loss include nutrition, particularly an iron deficiency; an over- or underactive thyroid gland; and illnesses such as cancer and autoimmune diseases. So it’s really important to check in with your doctor if you’re experiencing hair loss.

WHICH SUPPLEMENTS AND TOPICAL TREATMENTS REALLY WORK?

For certain types of hair loss, “Minoxidil, which is the active chemical in Rogaine, is helpful,” says Wechsler. “For years, we were telling women to get the men’s 5% because it works so much better than the 2.5% originally made for women.” There is now a 5% version for women. Some doctors, like Wesley, compound even stronger formulas for patients. “Our topical spray for women includes minoxidil; retinol for better delivery; melatonin, which topically has been shown to increase hair in the crown for women; and spironolactone—a medication used to treat acne and unwanted facial hair—which shields the hair follicles from androgens, the hormones that cause thinning,” he says. Wesley advises patients to spray on these custom blends five to seven times every night and prepare to wait for three months before seeing the first signs and a full six months before any real benefits.

Another topical strategy comes from Harklinikken, a Danish hair clinic that’s been studying women’s hair loss for over 30 years. A consultation, either in person (there are locations in New York, Beverly Hills, and Tampa) or virtually, determines whether you’re a candidate, meaning that you’ve got the potential to see at least a 30 percent improvement in hair gain. If you are a candidate, the company formulates a custom extract just for you, which you then apply daily. “Some of the key ingredients are burdock root, marigold, and proprietary constituents from cow’s milk,” says founder and lead researcher Lars Skjoth. “It’s about making the concentration powerful enough to nourish the scalp and hair follicle microbiome to help promote thicker and healthier hair.”

Wechsler likes to include biotin in her formulations. “It’s usually not amazing in terms of results, but it can be useful, especially in combination with other hair treatments,” she says.

Supplementing with biotin is generally considered safe, says Nutrafol’s director of product education, Brianna Diorio, PhD, MS; the only thing to know is that it can affect the results of lab testing for thyroid issues. The FDA warns that excessively high biotin consumption can cause incorrect lab results such as falsely elevated levels of T4 and T3 and low levels of TSH. “If you have a thyroid condition, we recommend waiting about 72 hours after you’ve stopped taking a biotin supplement before having blood collected for lab testing,” says Diorio. “And always consult your doctor when you’re beginning a supplement.”

Additionally, Wesley recommends taking an iron supplement with vitamin C (the latter helps improve iron absorption) to improve overall hair volume. Diorio seconds the vitamin C and iron, along with zinc: “Zinc is a mineral involved in various biochemical reactions that can impact hair health,” she says. “It’s essential for the formation and maintenance of hair follicle development.” She adds that research has also found that hair follicle cells can be particularly sensitive to decreased levels of iron: “They may not be able to grow new cells as effectively when iron stores are low.”

We’ve heard great anecdotal success stories with Nutrafol, as well as Wellbel, a new hair-supporting supplement coming out of the biomedical tech space. Both Nutrafol and Wellbel have biotin and zinc in their formulations (Nutrafol also has vitamin C).

HOW MUCH SHOULD WE WASH OUR HAIR?

Wesley says this is the question he gets most. “While there is no magical number of hair washes per week, it has been shown that cortisol and dihydrotestosterone—two hormones that can accelerate hair thinning—can be present in scalp sebum, which is our natural scalp oil,” he says. “So I recommend washing the scalp at least three times a week. It doesn’t necessarily have to be washed with shampoo, though—in some cases, you can simply wash the scalp with water.”

Scalp massage, done while shampooing or when your hair is dry, can help increase circulation, but its hair-preserving capabilities have not yet been proven. “The thing I love about massage is that it temporarily decreases cortisol levels,” says Wechsler. “But if someone really thinks massaging the scalp for 5 to 10 minutes a day is going to help grow their hair back…I don’t think that’s going to happen.” Made with chunks of salt and powerful botanicals, this shampoo nourishes, gently exfoliates, moisturizes, and soothes the psyche.

You can also massage with a scalp treatment—the one from the trichologist-founded hair brand Act + Acre is made with a special amino acid complex to soothe and balance, while Nécessaire’s is made with a biomimetic peptide blend to support hair growth.

CAN STYLING MAKE A DIFFERENCE?

“The only hairstyle that can cause real hair loss is very tight braiding,” says Wechsler. “It’s called traction alopecia. Anything else you do to the surface of the hair follicle can make the hair break but not fall out.” Hair that’s been broken off certainly doesn’t contribute to hair fullness, however, so avoid tight ponytails, overprocessing (chemical hair straighteners can do a number on your hair, particularly combined with hair coloring), and overstyling, particularly with heat. Hair brushing should be done gently. The flexible palm-size brush from Manta molds to the shape of your hand and scalp, creating less tension, while its bendy, forgiving bristles minimize snagged hairs (Manta’s founder, Tim Binnington, a British hairdresser, created it for his wife when she was growing her hair back after an illness and was worried that brushing was causing breakage).

On the other hand, some styling can make a difference in the appearance of thinning hair. “Product, product, product—and a powerful dryer,” says Harry Josh, a New York hairstylist and colorist and the founder of Harry Josh Pro Tools. “The right product depends on you and your hair, but it should feel weightless, with the ability to build texture and soft hold. Once you’ve got the product in your hair, use a round brush and start drying right at the roots. Pull up with the brush and hit the roots with the dryer to build the lift you need to create volume.”

WHAT ARE THE IN-OFFICE OPTIONS?

Procedures like platelet-rich plasma treatments for the scalp—similar to the ones used for rejuvenating the skin—help stimulate growth factors in the scalp. Doctors like Wesley and Robin Unger, MD, in New York use this technique as therapy for hair loss. They prepare plasma—containing platelets—from a patient’s own blood, concentrate it, and inject it directly into the skin of their scalp. Clinical results show a significant increase in hair density, thickness, and growth after three to six months.

Advancing research shows growing potential for stem-cell-derived therapy to help with hair growth. It uses bioactive molecules—growth factors, exosomes, cytokines, chemokines, and others—from stem cells to regulate the hair follicle cycle and regenerate hair growth. This is like PRP therapy but uses stem cells sourced from the patient’s hair follicles, which are separated out, then the molecules are injected directly into the scalp or applied topically. Doctors and hair-restoration experts like Craig Ziering, DO, specialize in this, as well as a technique known as cryopreservation of hair follicles or follicle freezing. Similar to the method of freezing eggs for fertility preservation, you can freeze and store these stem cells for future applications.

Transplants, Wesley says, have come a long way. He now starts by moving hair from one area (generally from the back of the head, which is typically less affected by hormone changes) to another area. “It works because we take more than just the hair shaft—we take the full anatomy of the hair follicle, which allows these newly placed hairs to continue to grow in a healthy manner.” There’s an art to the placement, too: “When coarse follicles are placed in the front, the spacing is too far apart, or the surgical design is too linear, it doesn’t make aesthetic sense,” says Wesley. “These are telltale signs of a ‘pluggy’ transplant. Ensuring the survival rate of the finest hairs at the optimal density leads to healthy facial framing.”

This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of goop.